Acne: causes, modern treatment and the right skincare

At a glance

FrequencyThe most common skin disease worldwide — above all in adolescents and young adults, possible at any age
What happensThe sebaceous glands produce too much sebum, the pores become blocked, and bacteria (Cutibacterium acnes) trigger inflammation
FormsComedones (blackheads), papules, pustules, nodules, cysts — from mild to severe
Treatment (mild)Topical creams/gels: retinoids, benzoyl peroxide, azelaic acid
Treatment (severe)Oral antibiotics, hormonal therapy, isotretinoin
ICD-10L70 (acne)

Table of contents

  1. What is acne?
  2. Forms and degrees of severity
  3. Causes
  4. Treatment: topical (mild acne)
  5. Treatment: systemic (moderate to severe)
  6. Isotretinoin
  7. Skincare and everyday life
  8. How brite helps you
  9. FAQ
  10. Related topics

1. What is acne?

Acne (acne vulgaris) is a chronic inflammatory disease of the sebaceous glands and hair follicles. It arises when the sebaceous glands produce too much sebum, the pores become blocked by excess horny cells, and bacteria (above all Cutibacterium acnes) multiply. The result is blackheads, pimples, inflamed papules, pustules and, in severe cases, nodules and cysts.¹

Acne is the most common skin disease worldwide. It affects above all adolescents during puberty, but can also occur in adulthood or begin for the first time then (acne tarda, late-onset acne) — especially in women.¹˒²

Acne is more than a cosmetic problem Acne can considerably impair quality of life, lead to scarring and is often associated with psychological distress — shame, social withdrawal, in some cases also depression. Early and consistent treatment is important in order to avoid scars.

2. Forms and degrees of severity

Comedonal acne (acne comedonica)
Predominantly open and closed comedones (blackheads and whiteheads). Mild form. Hardly any inflammation.
Papulopustular acne
Inflamed papules (red bumps) and pustules (pus-filled pimples) in addition to comedones. Moderate form.
Conglobate acne (acne conglobata)
Severe form with deep nodules, cysts, sinus tracts and scarring. Usually requires systemic therapy.
Acne tarda (late-onset acne)
Acne in adults, especially in women. Often in the lower jaw and chin area. Can be hormonally driven.

3. Causes

  • Hormones (androgens): the most important trigger. Androgens — male sex hormones that occur in both sexes — stimulate sebum production. That is why acne often appears during puberty.
  • Sebum overproduction: the sebaceous glands produce too much sebum.
  • Follicular hyperkeratosis: excess horny cells block the pore opening — comedones (blackheads) form.
  • Cutibacterium acnes: bacteria that multiply in the blocked follicle and trigger inflammation.
  • Genetics: a family predisposition plays an important role.
  • Diet: the connection between diet and acne is increasingly being discussed. Foods with a high glycaemic index (sugar, white-flour products) and, in some studies, dairy products too may possibly worsen acne. However, there is no general dietary ban.
What does NOT cause acne Acne does not arise from a lack of hygiene. Excessive washing and scrubbing can even irritate the skin and worsen the acne. The assumption "more washing = fewer pimples" is a persistent myth.

4. Treatment: topical (mild acne)

With mild to moderate acne, topical therapy (creams, gels) is the priority.¹

First line Topical active ingredients
Retinoids (e.g. adapalene) — first-line therapy
Dissolve comedones, inhibit inflammation and prevent new lesions.
Common reaction at the start: dryness, redness — introduce slowly
Common combination: with benzoyl peroxide for a stronger effect¹
Benzoyl peroxide (BPO)
Acts in an antibacterial and comedolytic way. Can be combined with retinoids or topical antibiotics. Important: can bleach textiles (towels, pillows, clothing).
Topical antibiotics (clindamycin, erythromycin)
Act against Cutibacterium acnes. Should usually NOT be used as monotherapy — only in combination with benzoyl peroxide or retinoids, in order to avoid resistance.¹
Azelaic acid
Acts in an anti-inflammatory way and against comedones. Can also be helpful with pigment changes after acne (post-inflammatory hyperpigmentation).
Patience pays off Topical acne therapies usually only show an effect after several weeks. A temporary worsening at the start ("purging") is possible with retinoids and is no reason to stop the therapy.

5. Treatment: systemic (moderate to severe)

With moderate to severe acne — or when topical therapy is not enough — systemic therapies are used.¹

Oral antibiotics (doxycycline, minocycline)
Are usually used for a limited time (mostly three to six months) — always in combination with topical therapy. Long-term treatment is not recommended, in order to avoid the development of resistance.
Important: do not take doxycycline together with milk, calcium or iron — otherwise the effect can be considerably reduced.
Hormonal therapy
In women with hormonally driven acne, certain combined oral contraceptives (the pill) or antiandrogens can be used. They act specifically on the hormonal component of the acne.
Isotretinoin
Its own section — see below.

6. Isotretinoin

Isotretinoin (a systemic retinoid) is the most effective medication against acne. It is used for severe or treatment-resistant acne and can, in many cases, achieve a long-term or lasting remission.¹

  • Inhibits sebum production, comedone formation, bacterial growth and inflammation — acts on all four acne causes at the same time
  • Treatment duration usually several months
  • Common side effects: dry skin and lips (almost always), dry eyes, nosebleeds, muscle pain, elevated liver values and blood lipids — regular blood checks are necessary
  • Intensive lip care and sun protection are particularly important during the therapy
  • Prescription only by an experienced dermatologist
Strictly contraindicated in pregnancy Isotretinoin is strictly contraindicated with an existing or planned pregnancy — because of a severe teratogenic effect (malformations). In women of childbearing age, strict requirements apply: reliable contraception before, during and for at least one month after the end of therapy, regular pregnancy tests. These requirements are discussed in detail by the prescribing dermatologist.

7. Skincare and everyday life

  • Cleansing: mild, pH-neutral cleansing in the morning and evening. Do not scrub. No aggressive peels. Water alone is mostly not enough — but too much cleansing is counterproductive.
  • Moisturizing care: a non-comedogenic (pore-friendly), oil-free moisturizer — particularly important during therapy with retinoids or isotretinoin, since these dry out the skin.
  • Sun protection: with topical retinoids and isotretinoin the skin is more light-sensitive — daily sun protection is recommended. More: Medications and the sun.
  • Do not squeeze: do not squeeze pimples and comedones yourself — this increases the risk of inflammation and scars. A professional extraction at the dermatology practice is possible.
  • Make-up: use non-comedogenic products. Remove make-up thoroughly in the evening.
  • Patience: acne therapies take time. An improvement usually only shows after weeks. An initial worsening ("purging") with retinoids is possible and no reason to stop.
When to see a dermatologist? When over-the-counter products do not help, with inflamed papules and pustules, with nodule formation, with scarring or when the acne impairs quality of life. An early start of therapy is the best protection against lasting scars.

How brite helps you with acne

Adapalene in the evening, doxycycline in the morning (not with milk!), the pill at the same time every day, plus sun protection and moisturizer — acne treatment is routine work. brite helps you stick with it.

  • Medication reminder — isotretinoin with a meal, doxycycline not with a milk-based meal, the pill at the same time every day: brite reminds you right on time. Set up a reminder
  • Interaction check — isotretinoin with vitamin A preparations? Doxycycline with dairy products or iron? Check interactions for free before they become a problem. Check now
  • Health history — document your skin's appearance, flare intensity, side effects such as dry lips or skin dryness, and lab values (liver values, blood lipids) clearly. Track your history
  • Digital medication plan — all your medications and topical products clearly laid out for dermatology, your family doctor and the pharmacy. Go to medication plan
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FAQ: Common questions about acne

No. Acne can also occur in adulthood or persist. Late-onset acne (acne tarda) affects women in particular and often shows in the lower jaw and chin area. It can be hormonally driven.¹
The connection is increasingly being discussed. Foods with a high glycaemic index (sugar, white-flour products) and, in some studies, dairy products too may possibly worsen acne. However, there is no general dietary ban. Testing things out individually can be useful.
The most effective medication against acne. It is used for severe or treatment-resistant acne and acts on all four acne causes at the same time. The therapy requires regular blood checks and strict contraception requirements in women of childbearing age, since isotretinoin can cause severe malformations in pregnancy.¹
No. Acne does not arise from a lack of hygiene. Excessive washing and scrubbing irritates the skin and can even worsen the acne. Mild cleansing in the morning and evening is usually enough.
Topical antibiotics (e.g. clindamycin), when used on their own, promote the development of resistant bacteria. That is why, according to the current guideline, they are usually always combined with benzoyl peroxide or retinoids.¹
Usually several weeks. With retinoids, a temporary worsening can occur at the start ("purging"). Patience and consistency are decisive. Isotretinoin usually has a clear effect within the first months.
Yes — especially with severe acne, with a late start of therapy and when squeezing pimples. Early and consistent therapy is the best protection against scars. Existing scars can usually be treated dermatologically (peel, laser, microneedling).
When over-the-counter products do not help, with inflamed papules and pustules, with nodule formation, with scarring or when the acne impairs quality of life. An early start of therapy prevents scars.

10. Related topics

Depression Drug interactions Medications and the sun Preparing for a doctor's appointment Taking medications correctly Side effects of medications

Sources

  1. S2k-Leitlinie Akne (DDG, AWMF Reg-Nr. 013-017, 2024). awmf.org
  2. gesundheitsinformation.de (IQWiG): Akne. gesundheitsinformation.de
  3. EDF/EADV Guidelines on Acne (European Dermatology Forum, 2024). guidelines.edf.one
  4. Deutsche Dermatologische Gesellschaft (DDG). derma.de
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. Acne medications — especially isotretinoin — require careful medical supervision with regular checks. Isotretinoin must not be taken with an existing or planned pregnancy, since it can cause severe malformations. The choice of therapy is always determined individually by the treating dermatologist. Last updated: April 2026.